As a returning traveller, you already submitted a Returning Traveller Isolation Questionnaire.

The form below is intended for individuals who received a call from the Returning Travellers Outreach Program call centre. It can be used as an alternate way to confirm the information requested by the Government of Alberta.

For program information, visit Covid 19 travel advice.

Complete form

A separate telephone call is not necessary once your form is submitted.

Please submit:

  • only one form per household
  • one adult as the primary contact
  • a list of all other travellers, including both adults and children,  who are isolating in the same household

All fields are required unless otherwise indicated.

Primary contact at location
Address where you and/or members of your household are isolating
Travel information
Are there any other returning travellers in your household?
Declarations

Your health information is being collected by Alberta Health for the purpose of managing the public health response to COVID-19 as ordered by the Chief Medical Officer of Health (05-2020). It is collected and used under the authority Sections 18 and 29 Public Health Act and Sections 20(b) and 27(1)(f) of the Health Information Act (HIA).

The confidentiality of this health information and your privacy are protected by the provisions of the Health Information Act and the Public Health Act. If you have any questions about this collection and use of your health information, please contact Alberta Health’s HIA Help Desk, 21st Floor, ATB Place North, 10025 Jasper Avenue NW Edmonton Ab, T5J 1S9, by phone at 780-427-8089 or email at HiaHelpDesk@gov.ab.ca.